False croup in children: what are the symptoms and what is the treatment. What is false croup? False croup: how to suspect

false croup, or acute stenosing laryngotracheitis, is a symptom complex that develops with inflammatory changes in the mucous membrane of the larynx and trachea due to edema in the subfold space.

Causes and mechanisms of development of false croup

main reason given state is an acute respiratory viral infection caused (most often) by influenza, respiratory syncytial virus, and adenovirus.

Less often, acute stenosing laryngotracheitis can be caused by bacteria - mainly streptococcus and staphylococcus aureus.
Often, false croup is a reaction of the body to the impact of a particular allergen, as well as a consequence of local trauma.

In adults, false croup is practically not found - they only have true croup, which develops with such an infectious disease as diphtheria.

False croup is a common complication in children under 6 years of age. This is due to the anatomical and physiological features of the upper respiratory tract of babies, namely:

• small size and narrow lumen of the larynx;
• a large number of loose connective and lymphoid tissues in the subglottic space (than younger child, the more this tissue is, and it is highly susceptible to edema);
• elongated, loose epiglottis;
• softness of the cartilaginous skeleton;
• highly developed circulatory and lymphatic systems in the area of ​​the upper respiratory tract.

The above features contribute to the occurrence of stenosis components against the background of inflammation - spasm and edema.

So... Due to inflammatory changes in the mucous membrane of the larynx, manifested by edema and the production of a viscous discharge, the lumen of the larynx narrows, its mucosa dries up, crusts form on it, which makes the lumen of the larynx narrower even more. When the child is anxious, there is also a reflex spasm. smooth muscle larynx.

Manifestations of the disease

Acute stenosing laryngotracheitis is characterized by the presence of 3 symptoms at the same time:

• hacking, rough barking cough:
• hoarseness, hoarseness of voice - dysphonia;
• so-called inspiratory stridor - difficult wheezing, wheezing, bubbling breathing.

In addition to the above symptoms, the patient may also have other signs of the underlying disease: fever body, runny nose, discharge from the conjunctiva (usually - with adeno viral infection), lacrimation.

It should also be noted that the described condition usually develops in the evening or at night during sleep, when the child is in a horizontal position.

In practical medicine, it is customary to distinguish 4 stages of laryngeal stenosis:

I - compensated stenosis. The child's condition is assessed as medium degree gravity. His consciousness is clear. At rest, breathing is free, even, with motor or emotional excitement, shortness of breath appears - when breathing, retraction of the jugular fossa (located above the sternum) and intercostal spaces is noticeable. Heart rate 5-10% higher normal values for this age. Periodically there is a rough barking cough.

II - subcompensated stenosis. The patient's condition is serious. The child is excited, his skin is pale, around the mouth - with a cyanotic tint. At rest, shortness of breath is noted - a loud breath with retraction of the intercostal spaces, jugular and supraclavicular fossae. The bubbling breath is interrupted by bouts of rough, deep barking cough. The voice is significantly hoarse. The heart rate is 10-15% higher than normal.

III - decompensated stenosis. The child's condition is extremely serious. There is a clouding of consciousness, a pronounced lethargy or, conversely, arousal. Inspiratory dyspnea is noted with extremely difficult inspiration, which is accompanied by a sharp retraction of the supraclavicular and jugular fossae, intercostal spaces, epigastric region(the area under the sternum - between the ribs and the navel). Exhalation is shortened skin pale, spreading cyanosis. The heart beats more than 15% faster than normal. Blood pressure drops.

IV - asphyxia - the child's condition is extremely serious. Consciousness is absent. Skin with a bluish tinge (cyanotic). The pupils are dilated. Breathing is rare or absent altogether. Heart sounds are deaf, their frequency is very difficult to calculate. The pressure is drastically reduced. Seizures are possible.

Diagnosis and differential diagnosis

Diagnosis is not difficult. The diagnosis is made by an ambulance doctor, pediatrician or otorhinolaryngologist based on anamnesis data (the condition developed against the background of SARS), a typical clinical picture diseases (the triad of symptoms described above), results objective examination sick ( visual inspection, assessment of the nature of breathing, cardiac activity, monitoring of indicators blood pressure). In a hospital, laryngoscopy is performed (for the purpose of visual assessment of the state of the mucosa), taking a swab from the throat, followed by microscopic examination and inoculation on a nutrient medium (to verify the pathogen). For the purpose of assessing the degree oxygen starvation organisms are being tested gas composition blood and acid-base status.

According to the indications, in order to diagnose the underlying disease or possible complications, the following can be performed:

• otoscopy;

False croup must be differentiated from true diphtheria croup, acute epiglottitis, retropharyngeal abscess, foreign body in the larynx, and acute obstructive bronchitis.

True diphtheria croup is accompanied by a low (subfebrile) temperature, in a hoarse voice(the patient, as it were, “talks through his nose”). Runny nose and other catarrhal phenomena are absent. Signs of stenosis develop gradually. On examination oral cavity the tonsils attract attention: they are enlarged, with dirty gray films that are difficult to remove with a spatula. From the mouth of the patient - the smell of rot.

Acute epiglottitis is an inflammation of the epiglottis. Signs of stenosis of the larynx increase gradually, are characterized by severe inspiratory dyspnea, dysphagia and general anxiety of the patient. His condition is serious, the position of the body is forced (sitting), the temperature rises to febrile numbers. Examining the oral cavity, you can see the root of the tongue dark cherry color. During laryngoscopy - swelling of the epiglottis and epiglottis.

A retropharyngeal abscess always debuts acutely with an increase in body temperature to febrile numbers, increasing shortness of breath with difficulty in inhaling, turning into suffocation, with a pronounced general anxiety. The position of the patient is forced - with the head thrown back and to the affected side. Breathing is snoring, difficult especially in the position of the patient lying down. Salivation is increased. When examining the pharynx, a protrusion of its posterior wall and a fluctuation symptom are noticeable, indicating the presence of an inflammatory fluid in the study area.

The presence of a foreign body in the larynx, partially covering the lumen of the organ, is evidenced by the sudden onset of the disease, the patient's anxiety, complete absence signs of inflammation and toxicity. In case of complete obstruction, the patient cannot breathe or speak. He points to his neck. There is inspiratory stridor, paroxysmal cough.

If false croup has developed once, parents should keep in mind that it can recur, and, after consulting a doctor, stock up on medications that can be useful in case of an illness.

About the treatment of false croup in the program "School of Dr. Komarovsky":

Most often, the disease affects young children, although cases of the development of false croup in adults are also known to medicine. The danger of such a state is that in the absence of qualified assistance the threat to the life of the patient increases.

General information

False croup, or stenosing laryngotracheitis, is a disease in which stenosis (narrowing) of the larynx is observed. Due to the fact that the development of a false croup provokes edema and inflammation, the disease is classified as infectious-allergic. It usually occurs as a complication of the upper respiratory tract. Children at risk are younger preschool age, which is explained by the peculiarities of the structure of their trachea and larynx.

Important! According to statistics, false croup is diagnosed several times more often in boys than in girls.

In adults, the disease manifests itself in one single case, when an allergen enters their body and provokes a strong allergic reaction, accompanied by edema and stenosis of the larynx. At this moment, the lumen of the respiratory tract narrows, an asthma attack begins.

Note! Along with the concept of false croup, in medical practice there is also a concept. The latter develops under the condition of damage to the larynx and is distinguished by the appearance of a film and plaque on the mucous membranes. With a false croup, there is simply redness and swelling of the soft tissues, which provokes squeezing of the respiratory tube.

The peak of the development of the disease falls on the off-season. During this period, children decrease, and the risk of developing a bacterial or viral infection increases. In most cases, false croup resolves on its own if the patient is provided optimal conditions stay indoors, facilitating his condition. However, for 5-10% of children, such a disease is incredibly dangerous and requires immediate hospitalization.

A suddenly appeared false croup can be carried by a child once in a lifetime. Meanwhile, in practice, it is almost always repeated. Most of all, emotional, excitable children, who, moreover, have an allergic predisposition, are most susceptible to it. In some of them, stenosis occurs literally with any runny nose or with any mild infection. However, by 6 to 8 years of age, cereals usually stop. It is believed that the child outgrows them, but in fact everything is explained by the expansion of the lumen of the larynx, in which the edema ceases to present serious danger for life.

Cause and effect

Most often, false croup develops against the background of another disease.

In this case, the development of pathology can provoke:

Can cause laryngeal edema and stenosis bacterial infections, namely:

• enterococci and;
• pneumococci.

Important! Bacteria cause false croup extremely rarely. However, if this happens, the patient's condition worsens, and the disease is more severe. Sometimes a false croup can develop as a result of chronic tonsillitis.

It is worth remembering that not every child of primary preschool age is susceptible to the disease.

Usually its appearance is promoted by:

• transferred;
• , which was diagnosed during childbirth;
• frequent diathesis;
• absence breastfeeding in the first months of a baby's life;
• avitaminosis;
• low, including in the period after vaccination;
• prone to allergic reactions.

The mechanism of development of false croup is extremely simple: the larynx becomes inflamed, which entails severe swelling in the area under the vocal cords and narrowing of the lumen of the larynx. The reflex spasm of the constrictor muscles aggravates the situation. In response to inflammation, the glands of the mucous membrane begin to secrete more secretions - thick sputum, and the person has difficulty breathing.

Important! On the early stages the development of the disease, the lack of oxygen is compensated by intensive breathing and increased work of the respiratory muscles. When the stenosis worsens, the flow of air becomes difficult. In the absence of qualified medical care, in this case, the onset of oxygen starvation is possible, which entails damage to the central nervous and cardiovascular systems, and after them - damage to organs and tissues. That is why false croup is the main cause lethal outcome in children of the first year of life.

Symptoms of false croup

Doctors distinguish several stages of false croup, each of which is characterized by its own symptoms:

Note!Usually, the disease makes itself felt at night, after 2-3 days have passed since the development of the disease, which served as an impetus for the appearance of stenosis of the larynx. Symptoms can persist from several hours to several days.

In the case of timely assistance, the prognosis is favorable.

In order not to lose time, doctors advise to apply for medical care already at the time of:

• hoarseness;
• restlessness and irritability;
• sharp "barking" cough;
• shortness of breath and rapid breathing;
• kind of squeaky breath.

First aid for false croup

The success and speed of treatment of false croup directly depends on the timeliness of first aid. Any delay can provoke the progression of the disease and serious complications.

Therefore, in the event of shortness of breath against the background of an acute viral infection, it is necessary:

Usually, such procedures alleviate the condition of the child, but if this did not happen, and the team of doctors has not arrived yet, you can additionally give the patient:

• in age dosage;
• antispasmodic, for example, No-shpu;
• preparation with salbutamol in the composition (bronchoril syrup or Ventolin inhalation).

Important! If there is no drug with salbutamol, you can inhale the respiratory tract with saline. The main thing is that the child at this moment should not be capricious and not nervous, as excessive anxiety provokes new attacks. It is also important to replace clothing that restricts breathing with the most spacious.

Treatment of false croup

The younger the child, the more likely that he will treat false croup in a hospital under the supervision of an experienced specialist.

To alleviate the condition, small patients are prescribed:

• various decongestants, including inhalations with saline or naphthyzinum;
• hormone injections, as they quickly relieve swelling and prevent the development of complications;
• or drugs, depending on the nature of the disease that provoked stenosis of the larynx;
• to remove ;
• antitussive drugs if the condition is accompanied by a severe cough.

If all the above remedies do not help, doctors prescribe tracheal intubation or tracheostomy with the installation of a breathing tube, which remains in place until the swelling subsides.

Additionally, at this stage, the condition can be alleviated by daily ventilation and humidification of the room, bed rest, refusal of hot, cold or overly spicy food.

Do not smoke near the patient, as well as spray aerosols, as such a smell can provoke complications.

Important! During an attack of false croup, a person may develop a reflex spasm of the larynx, which can be prevented by pressing on the root of the tongue and, thereby, provoking vomiting. It is also worth tickling the patient’s nose and making him sneeze, which further alleviates the condition.

What can not be done with a false croup

The desire to help the child in any way at the time of an exacerbation of the disease can force parents to take various measures to prevent the worst. In a normal situation, of course, they can help, but in the case of a false croup, they will only harm.

This is about:

• rubbing, especially means with essential oils, which can increase swelling in a small allergic person;
• the use of mustard plasters;
• the use of honey raspberry jam, citrus fruits, which accelerate stenosis;
• the use of drugs with codeine, which suppress cough - protective function organism, thanks to which he tries to help himself.

Prevention of false croup

It is impossible to protect a child from a suddenly appeared false croup, but it is quite possible to prevent its development.

• Start hardening the throat. It is carried out as follows: the child is given a glass of water to gargle. First, this water must be room temperature but gradually getting colder. Only after a few months of daily procedures, you can gradually switch to rinsing cold water. However, haste in this case is a sure cause of the child's illness.
• Review the diet. Most often, citrus fruits, bright fruits, chocolate, spices provoke the development of allergic reactions, which cause the development of false croup.

By itself, laryngitis and laryngotracheitis do not pose a serious danger, but in some cases they are complicated by bouts of false croup. Acute stenosing laryngotracheitis or - a disease that occurs in children from six months to two or three years. Until now, the mortality from this disease is quite high. Often, mothers are simply lost when a child has an attack of stenosis, they lose precious minutes, not being able to recognize the onset of the disease in time, and, of course, to provide needed help.

Basic terms to make it clear:

• Stenosis and obstruction- in this case, mean the very narrowing of the subglottic space, which is caused by mucosal edema.
• Auxiliary muscles are the muscles that healthy condition are not involved in respiration. They begin to participate in breathing only in case of difficulty. Accessory muscles include the wings of the nose, abdominal muscles, intercostal muscles, and muscles in the collarbone region.
• Inspiratory dyspnea- difficulty breathing.
• false croup- this is an edema of the mucous membrane below the vocal cords, which has a viral or bacterial-viral origin.

The younger the child, the more severe this disease is. Of course, there may be exceptions. Features contribute to the occurrence of laryngeal edema child's body. The glottis in children is narrow, its muscles get tired easily (even after a cry), vocal cords and the mucous membrane is tender, their blood supply is very good, which determines the tendency to edema and the occurrence of stenosis (narrowing) of the larynx.

False croup has also been described in infants and older children. age group. Laryngeal edema can be both the first manifestation of the disease, and a "gift" on the "tail" of the underlying disease. This condition can occur against the background of any body temperature. The attack, as a rule, occurs at night in the morning. There may be a recurrence of an attack after treatment. There are children who accompany each infection with attacks of suffocation. Most often, false croup can be expected from allergic children.

The disease is caused, as a rule, by viruses, and develops gradually, over several days.

False croup: how to suspect?

False croup develops most often suddenly, at night. A child may go to bed apparently quite healthy, and at night completely unexpectedly wake up excited, with bouts of loud "barking" cough.

In addition, there is hoarseness of voice, shortness of breath. Already at a distance, a whistling labored breath is heard, which, in turn, causes tension in the auxiliary respiratory muscles, nostrils flaring, tension in the muscles of the child's neck.

The skin, during an asthma attack, becomes bluish, the heart rate increases. The body temperature most often does not exceed 38ºС. An asthma attack lasts an average of 30 minutes to 2 hours and gradually disappears.

signs mild form edema appear mainly with crying and anxiety. There is a "barking" cough, an elongated noisy breath, without the participation of auxiliary muscles. AT calm state shortness of breath subsides, but noisy breathing persists.

With an average severity false croup in a child, the above symptoms complement the marked excitement, sweating, marble pattern skin covers. Auxiliary muscles take part in the act of breathing (the wings of the nose swell, tension of the neck muscles occurs).

When the glottis becomes even narrower, the so-called decompensated stenosis, the condition of the child is serious. Inhalation at rest is noisy, prolonged, labored. The skin is pale with an earthy tint, covered with cold sweat, persistent cyanotic color of the tip of the nose, lips, fingers. Excitation is replaced by lethargy, periodically the baby shudders. In very severe cases possible loss of consciousness and respiratory arrest.

ATTENTION! If your child has a bout of "barking" cough and difficulty breathing, call the doctor immediately.

urgent first aid with stenosis:

1. Try to calm the child by removing extra people from the room. The groaning of grandmothers will only frighten the baby, and it will be easier for you when you are left alone with the child.

2. While you are taking care of the baby, have someone call an ambulance.
(Be sure to call an ambulance team for any degree of stenosis. Only a doctor can say for sure that your child has a false croup, and not an attack bronchial asthma, pneumonia or foreign body in the airways.)

3. Let the child breathe in cool, humidified air if possible. Be sure to ventilate the room where the child is. Cold air reduces swelling of the mucous membranes. To do this, wrap the baby and you can go to the window or go out onto the balcony, breathe through the open window. In the summer, you can open the freezer door and try to take a few breaths there. Remember, without fanaticism, sharply cold air when moving a child from a deliberately warm room to a very cold one, on the contrary, can cause reflex sasm of the larynx (narrowing of the airways) and aggravate the course of the disease.

4. Be sure to give the child any allergy remedy available at home: suprastin, fenkarol, diphenhydramine. AT emergency you can give the child a whole tablet, regardless of age. Give half a pill - it won't get worse. One-time use overdose Allergy medication won't hurt. Antiallergic drugs help reduce swelling and limit the area of ​​its spread.

5. If there is an inhaler in the house ( nebulizer), you can carry out inhalation with a 0.05% solution of naphthyzinum, lasting up to 5 minutes.

To prepare an inhalation solution, a 0.05% drug should be diluted with saline in a ratio of 1:5 (per 1 ml of the drug 5 ml of saline) or a 0.1% drug should be diluted in a ratio of 1:10 (per 1 ml of the drug 10 ml saline).

To relieve edema, 2 ml of the resulting solution is inhaled once, if necessary, the procedure is repeated.

Be careful, such inhalations are fraught with an overdose of naphthyzinum. This method should be used only in extreme cases.

6. Do not impose on the child bed rest. The child himself knows what position of the body in this moment will make it easier to breathe.

7. Give warm alkaline drink. It could be milk or mineral water. Can be added to milk baking soda on the tip of a knife. It is better not to give hot drinks because it causes additional swelling of the soft tissues of the throat and irritates the mucous membranes. The optimal temperature of the liquid is the one that is pleasant for the child. Children themselves feel the need to drink and, as a rule, do not refuse. It is better to give liquid in small portions after 5-10 minutes. Large volume drunk can provoke vomiting at the height of a coughing fit.

In any case, even if you managed to relieve an attack of false croup on your own, do not leave the child without medical supervision, call the local doctor. If you are offered hospitalization - do not refuse. Or you can boldly insist on hospitalization for observation. Often, attacks of false croup tend to recur for short periods of time.

Prevention of false croup:

In the room where the sick baby is located, the air should be warm, fresh, humidified, but not damp.

Be sure to give your child antihistamine (anti-allergic) drugs at a time when he is sick. This will help, if not avoid, then reduce the risk of occurrence and severity of an attack of false croup.

A fairly common syndrome during a viral or, less commonly, bacterial infection of the respiratory tract is false croup in children. Its danger lies in the rapid, and sometimes lightning-fast development, the need to take certain measures even before the arrival of the medical team. The most susceptible to it are children from one to 5 years old, especially those who have undergone birth trauma, hypoxia in childbirth or fed artificially.

But even absolutely healthy, rarely ill children can suffer from false croup: an excessive immune response to the introduction of certain viruses and bacteria into the mucous membranes of the respiratory organs is expected.

False croup is a lack of air intake into the child's body, caused by a narrowing of the glottis due to edema. The child's larynx is narrow (from 0.5 cm), and in case of infection, its walls thicken, swell, which significantly reduces the lumen of the windpipe. Increased mucus production in response to infection also reduces the diameter of the airways. In addition, a reflex spasm of the ligaments often joins, which makes it difficult for air to enter the lungs.

The cause of false croup is catarrhal diseases: SARS, and parainfluenza (most often), scarlet fever,. If microbes from the tonsils with angina penetrate the larynx, then a false croup may develop bacterial origin. It happens less often than viral croup, but is no less difficult to tolerate.

A predisposition to the development of croup during the period of an infectious disease is in children prone to allergies.

Important! Unlike true croup, when dense diphtheria membranes blocking the throat create an obstacle to air movement, false croup occurs precisely because of the narrowing of the glottis.

Most often, false croup in children is an acute and ongoing condition. Subacute (developing gradually) course is observed in children with chronic processes- tonsillitis, adenoids, polyps in the nose, diseases of the oral cavity. In this case, the symptoms of the disease are not detected at once, but appear gradually, the body adapts to new conditions before the condition worsens. Therefore, often stenosis of the larynx is not detected immediately. Children with a clear picture of croup in subacute development feel satisfactory when, with acute course the condition is more severe.

False croup in children symptoms and treatment

Symptoms of false croup and stages of development of the syndrome

The main feature is that the likelihood of developing respiratory disease false croup is large, - respiratory failure. The slightest signs shortness of breath should alert parents, force them to be on the alert, take preventive measures.

Croup can come on suddenly, develop quickly and short span time to overcome the path from a slight malaise to a severe irreversible condition. But in most cases before terminal stage does not reach, from the vivid manifestations of the disease, the body returns to its original state just as rapidly. But for this you need to know the symptoms and be able to help the child in time.

False croup proceeds in 4 stages. If timely measures are taken, the negative dynamics can be stopped at stages 1-3. Symptoms of the disease are shown in the table.

Stage I. Compensation

Respiratory features: shortness of breath only with emotional or physical activity. It is expressed not so much by an increase in breathing, but by a lengthening of inhalation, the disappearance of a pause between inhalation and exhalation.

Feeling satisfactory, symptoms of the underlying disease (fever, cough, runny nose, etc.)

Outcome: Recovery or transition to the second stage.

Stage II. subcompensation

Respiratory features: shortness of breath, even at rest, rapid breathing. Breathing is difficult and accompanied by wheezing. To ensure breathing, auxiliary muscles are connected - the muscles of the chest, abdomen, when inhaling, the wings of the nose swell. Cyanosis (cyanosis) of the nasolabial triangle. Rough barking cough.

The child is restless, touches the shirt collar, feels fear, cries.

Outcome: Regression of the syndrome or transition to the stage of decompensation.

Stage III. Decompensation

Features of breathing: suffocation, paradoxical breathing - superficial and infrequent, pallor of the skin.

The child is lethargic, apathetic, there is no activity, consciousness is unstable, confused.

Important! Spontaneous elimination of the syndrome at this stage is rare, urgent help is needed.

Stage IV Terminal

Features of breathing: respiratory arrest and a drop in cardiac activity.

Increased pallor, loss of consciousness, involuntary discharge of urine and feces.

Outcome: Clinical death.

Treatment of false croup syndrome

At the first signs of shortness of breath, it is necessary to take measures to stop the attack and eliminate the conditions for its development. The patient's parents should:

• Immediately call an ambulance - if you suspect croup, the child needs medical checkup and, as a result, hospitalization or outpatient treatment;
• Create calm atmosphere around the patient - do not shout, do not even talk loudly, express confidence in behavior that the situation is under control;
• If the patient is frightened, take the child in his arms, do not leave him alone in the room - nervous tension causes a reflex contraction of the muscles of the ligaments, which aggravates the situation;
• Provide an influx of cool moist air - it is best to open the window, even in winter (pre-wrap the child) - cool air reduces the volume of mucous membranes, and moisture dilutes the secret;
• You can carry out inhalation with a nebulizer - inhalation of cold vapor will improve the child's condition;
• In the absence of an inhaler, the child is brought into a bathroom filled with steam (it cools in the air), where it is useful to carry out distracting foot baths.

These are simple but urgent measures should help stop the development of false croup and wait for the arrival of doctors.

Important! In most cases, doctors offer hospitalization - you should not refuse it: only in a hospital is it possible to provide round-the-clock qualified monitoring of the development of the disease.

Prevention of false croup

False croup is a disease of young children. This condition can occur repeatedly in one child, as a relapse during one illness or with the next illness.

And in adults and children over 6 years of age, croup is extremely rare, as in infants under one year old. To the younger school age danger severe development events is very unlikely - the experience of overcoming various childhood illnesses affects.

Since false croup in children occurs during infectious diseases, it is obvious that it is required to ensure that the child is less sick. However, this does not mean that isolation is necessary to prevent infection. In children, whose immunity rarely meets with infection, the body's reaction to accidental contact with the pathogen, even the most banal one, may be excessive. And this is a direct road to cereals.

The most important thing is the hardening of the body. It is necessary to ensure that the change in temperature environment, wind or draft did not become a problem or cause the introduction of infection. From the first days of life, children should breathe clean air, walk a lot every day, and be active. Warm and dry air irritates the respiratory tract more than frosty air. Complete nutrition provide correct exchange substances and development appropriate for age.

Contacts with peers will teach immune system respond correctly to germs and viruses, most of which will not harm the child. These measures, of course, do not guarantee that the child will avoid croup, but it will be easier for the body (and parents) to cope with it.

Remember what to put correct diagnosis only a doctor can, do not self-medicate without consultation and diagnosis by a qualified doctor. Be healthy!

None of the children are immune from this. severe complication like false croup. Syndrome with stenosis (narrowing) of the larynx can occur suddenly against the background of any viral disease, bad cold and even allergies. We will talk about how and why false croup develops and how to provide the child with the necessary assistance in this material.

What it is?

Croup may develop as a complication during severe inflammation larynx. Its occurrence is always closely connected with severe swelling tissues, their increase in size, and, as a result, narrowing of the larynx in the narrowest place - in the region of the vocal cords.

True croup is swelling and shortness of breath only in the area of ​​​​the ligaments, it occurs with diphtheria. False croup is more common and large quantity causes of occurrence. It is less dangerous than the true one, but with untimely treatment or improper care can also lead to death.

In children, the respiratory organs have certain age differences that contribute to the development of croup. Their respiratory tract is loose and narrow, the larynx is smaller than in adults, in size and proportion. As a result severe swelling that accompanies, for example, laryngitis or laryngotracheitis can in literally the words "shut off" the child's oxygen.

At risk for such a complication in ARVI, influenza and other frequent and typical childhood diseases, - babies from birth to 3 years. This age group accounts for more than half of all reported cases of false croup. After 6-7 years, children are much less at risk of suffering such a complication, and after 10 years, the risks are practically reduced to zero.

The reasons

Most often, the cause of the development of false croup is the parainfluenza virus, other pathogens of acute respiratory viral infections, influenza, acute respiratory infections. The most severe forms of complications with stenosis are caused by influenza A and B strains, and, of course, adenoviruses. Bacteria by themselves rarely cause inflammation and swelling of the larynx and adjacent departments. respiratory system. But they can join as a secondary infection.

Croup rarely develops on its own. In 99.9% of cases, false croup acts as a complication of rhinitis, pharyngitis, laryngitis, chickenpox, scarlet fever, and chronic tonsillitis in the acute stage. As contributing factors we can consider weak or weakened immunity of the child, who, due to age and the underlying disease, cannot resist the spread of the inflammatory process, prematurity, rickets, and others systemic diseases that the baby may have.

False croup differs from most diseases of the respiratory system in its ability to cause stenosis, in which the larynx closes critically, and sometimes completely, preventing the child from breathing.

Muscle spasms only increase stenosis. And the mucus that is actively produced by the mucous membranes during inflammatory process, "complement" this alarming picture and create an additional obstacle to the passage of air into the lower respiratory tract.

False croup can develop in stages, or it can stop at one of the stages and begin to reverse development. obstructive syndrome on initial stage causes slight oxygen starvation, but the child's body, which knows how to compensate for everything, gives depth and saturation to the breath and compensates for the condition as best it can.

If the edema increases and the stenosis becomes more pronounced, the stage of decompensation will begin. Oxygen deficiency will "hit" cardiovascular system, kidneys and brain. This may cause severe consequences up to asphyxia or death from cardiovascular insufficiency.

Kinds

False croup caused by inflammation of viral origin will be called viral, and if stenosis has become a consequence bacterial infection, then the croup will be called bacterial.

However, information about the pathogen will be secondary, the doctor will put other information in the first place - what type of croup the child has according to the degree of complexity and severity of stenosis.

On this basis, false croup happens:

• First degree. This is a compensated stenosis, in which the child has shortness of breath during activity, movement, load. Inhalation is more difficult than exhalation.
• Second degree. This is a croup with subcompensated disorders, in which shortness of breath appears in a child not only during exercise, but also at rest.
• Third degree. In this condition, oxygen starvation develops, shortness of breath is severe, lips may begin to turn blue, skin integuments may turn pale. The child has difficulty breathing.
• Fourth degree. This is the last and most severe degree of complication, in which deep hypoxia develops, which can be fatal. All organs and systems of the child's body suffer, and primarily the brain and nervous system. Some changes, even if the child can be saved, will be irreversible.

Symptoms

False croup does not develop from the very beginning of the underlying disease. Usually, the first signs of laryngeal edema with stenosis begin 2-3 days after the onset of the disease. notice warning signs parents can on the most important diagnostic symptom- the appearance of a dry barking cough, which is often called "seal barking".

The cough is very rough, hysterical. As the edema develops, hoarseness may appear, but the voice does not completely disappear with false croup, as it happens with true diphtheria. During crying, coughing, the voice will intensify, and this is one of the main differences between a false croup and a true one.

Another feature- noisy breathing. It changes from the first minutes of the development of the croup. It becomes dry, whistling, the degree of sound effects directly depends on the degree of narrowing of the larynx, on the stage of stenosis. In the initial compensated stage, shortness of breath will be insignificant, whistling will be episodic. In the second stage, shortness of breath will become dry and frequent, it will prevent the child from sleeping and concentrating, the first vascular disorders- Paleness of the skin will appear.

At the third decompensated stage, hoarseness and cardiac arrhythmias appear. The child ceases to be active, he is very drowsy, lethargic, because he experiences severe oxygen starvation. The baby may begin hallucinations, delusions, episodes of loss of consciousness. On the last stage false croup disappear most characteristic symptoms- Barking cough and wheezing on inspiration. The child's blood pressure drops, may appear muscle cramps, consciousness leaves him, plunging the baby into a hypoxic coma.

Most often, attacks of false croup occur at night. They are accompanied not only severe shortness of breath and choking cough, but also panic fear, crying, anxious baby. The child must be given emergency care.

Diagnostics

FROM correct definition Diagnosis by children's doctors usually does not cause problems. Complaints about the underlying (usually viral) disease, cough, runny nose, heat, shortness of breath will definitely force the doctor to listen more carefully to the lungs of the child. By the nature of wheezing, false croup is not like any other disease, it is almost impossible to confuse it.

To make sure viral origin diseases, as well as to identify possible bacterial infections that could join, take a swab from the pharynx for bakposev. If the doctor has reason to believe that the child has hypoxia caused by false croup, he will definitely conduct an analysis of the oxygen content in the blood, the so-called KOS (acid-base) analysis.

To see the place of narrowing of the larynx, and also to evaluate possible complications, helps X-ray. X-rays of the lungs and paranasal sinuses are prescribed.

Urgent care

During an attack with a false croup, it is required to be able to provide emergency care correctly and quickly. It is to immediately call " ambulance". While the doctors are traveling, parents should try to calm the baby, because the inability to take a full breath frightens him, and during a fright, the muscles spasm and respiratory failure becomes even more severe.

The child must be put to bed and covered warm blanket, all windows and vents in the house must be opened, and if necessary, take the child to the balcony so that he has constant access to fresh air. The influx of oxygen significantly facilitates the condition of the child.

The baby can be given one dose antihistamine drug permitted by age and in strict accordance with age dosages. It could be "Suprastin", "Loratadine", "Tavegil". These drugs help to quickly reduce tissue swelling, and with a decrease in swelling, breathing will become freer.

No other drugs needed, with the exception of antipyretics, if the child has a high fever. In order not to complicate it already serious condition febrile seizures, after the thermometer shows a temperature above 39.0 degrees, you need to give "Paracetamol" or "Ibuprofen" but should be avoided acetylsalicylic acid ("Aspirin"), since it can lead to the development of Reye's syndrome in babies.

This is where first aid ends. All other manipulations are carried out by a doctor. At severe forms false croup, the child may need to be intubated. Therefore, it is impossible to refuse hospitalization in any case. Once removed, an attack of false croup may well return in a few hours, but it will be even more difficult and swift to recur.

Treatment

false croup mild degree can be treated at home. Moderate pathology is treated in a hospital, severe croup requires ward conditions intensive care.

• Easy degree. One of the most available ways false croup treatment mild stage with minor stenosis are inhalations. For such procedures, it is best to use special devices- inhalers. Unlike a pot of potatoes or a bowl of boiling water, steam inhalers at correct use do not cause burns of the respiratory tract.

With croup, the child should not be inhaled with herbal and essential components. They are irritants and can increase the degree of stenosis.

For inhalation, it is desirable to use ordinary water vapor or saline. A nebulizer with croup is ineffective, since the principle of its action is to bring fine particles medicinal substance to the lower respiratory tract (bronchi and lungs).

A doctor should prescribe inhalations. A child with false croup, even if expressed in a very mild and mild stage, must be observed by a specialist, since the line between mild stenosis and critical narrowing of the airways is too thin.

As the main treatment, drugs are prescribed that are necessary for the treatment of the underlying disease. Usually these are some antiviral agents(if necessary - "Tamiflu", other drugs - at the request of the parents, since most modern antiviral drugs have no proven efficacy), vitamins, antipyretic drugs based on paracetamol. For rinsing sore throat solution can be used "Derinat".

• Average degree. It is best to treat false croup with severe shortness of breath and incipient hypoxia in a hospital, since quite serious medications will be used in therapy, many intramuscularly and intravenously. Usually for removal respiratory failure use glucocorticosteroid hormones such as Prednisolone or Dexamethasone. In addition, the child is prescribed anti-inflammatory drugs, mostly nonsteroidal, as well as the introduction of intravenous solutions with nutrients, vitamins. Separately, it is worth mentioning the use vascular preparations, the introduction of which makes it possible to reduce negative impact oxygen starvation on the brain, nervous system child.

Dose "Dexamethasone" with medium-light false croup, it is 0.6 mg per kilogram of the baby's weight. If the symptoms are not too pronounced, it is allowed to take the drug through the mouth. With moderate severity of croup, most often the drug in the same dosage is administered intramuscularly.

For children with such a false croup, inhalation with adrenaline is often performed. In this procedure, a nebulizer is used to disperse the medicine ( "Epinephrine") into very small particles, which quite easily penetrate the bronchi, trachea and lungs. Most often, this helps to avoid intubation. However, among doctors, such treatment causes heated discussions - some experts argue that the inhalation of adrenaline is a placebo effect, others are sure that it is great way to relieve an attack of respiratory insufficiency. This inhalation is carried out in a hospital, since the child after it needs several hours to be under medical supervision.

• Severe degree. In severe forms of false croup, a stay in the intensive care unit is indicated until the moment when the threat of suffocation has passed. The child is then transferred to general department. Treatment consists of administering "Dexamethasone", inhalations with adrenaline, as well as the supply of oxygen from the outside. Every tenth baby with severe false croup requires endotracheal intubation. During manipulation, a special tube is inserted into the trachea, which provides artificial airway patency.

However, not all so simple. Quite often, the tube, like a foreign body, injures the inflamed area of ​​the respiratory system, and then the so-called subglottic stenosis develops. That is why it is recommended to remove the tube as soon as the child begins to breathe on his own, without leaving it in the trachea "just in case".